Bulgaria risks EU fines by giving private hospitals a blank check for medicine purchases

Bulgaria faces heavy fines from the European Commission for ignoring an infringement procedure initiated in 2019 due to the lack of obligation for private hospitals to carry out public medicine contracts.

On September 29, the majority in the Bulgarian parliament confirmed the continuation of this practice, a violation of EU law, according to the EU executive.

This is an unequivocal violation of EU law, for which there has been an infringement procedure against Bulgaria since 2019. We will pay hundreds of thousands of euros in our taxes (every day), MP from the pro-EU We Continue the Change coalition – Democratic Bulgaria Vasil Pandov said.

This coalition is the main political force supporting the government.

In early September, parliament began debating the government’s proposed changes to the Public Procurement Law to put an end to the violation.

Currently, large licensed private hospitals can use public money to purchase medicines and treat patients, but unlike public hospitals, they are not required to hold competitive tenders and instead purchase medicines through direct negotiation.

These rules provoked a public scandal four years ago, when the former manager of the National Health Insurance Institute, Decho Dechev, announced that private hospitals were paying eight times more than state hospitals for the same drug (Pemetrexed) for the treatment of oncological diseases, with the price varying between 65 and 530.

Data provided by Dechev showed that private hospitals purchase more of several drugs at higher rates than state hospitals, although the biggest difference concerns mainly Pemetrexed.

This led to a parliamentary scandal and accusations of corruption and lobbying by the opposition in the third government of Boyko Borisov, in power at the time.

In 2020, GERB’s health minister was financier Kiril Ananiev, who announced that he would propose a change in the law to oblige private hospitals to make public purchases when using public resources.

Three years later, the change has still not been adopted and, in parliamentary proceedings at the end of September, GERB voted again against requiring private hospitals to submit proposals.

The European Commission has initiated infringement proceedings against Bulgaria on the grounds that private hospitals are placed in a privileged position compared to public hospitals when using state resources.

Bulgarian law allows private hospitals to stock medicines preferentially because they pay higher prices, including trading through affiliated companies, declaring higher medicine prices and being fully reimbursed by the State.

Later, in October 2023, the Bulgarian parliament will vote on the government’s proposal to prohibit hospitals from paying different prices for the same medicine.

According to unofficial information from Euractiv, this proposal is also expected to be rejected due to opposition from large private hospitals and drug suppliers.

The private healthcare sector argues that imposing a price cap will lead to enormous difficulties in the supply of medicines and will ultimately worsen the problem of unavailability of rare medicines.

The majority in parliament also rejected another important government proposal – eliminating the ability of public and private hospitals to purchase, without a public tender, unregistered medicines that are not marketed in Bulgaria, but which have no alternatives for treating a given disease.

These are mainly medicines for the treatment of oncological, rare and other diseases that are not registered in Bulgaria due to the lack of commercial interest of manufacturers due to the small size of the local market.

In order not to leave patients in the country without treatment, hospitals began to order them as needed, without the need for public procurement processes.

(Krasen Nikolov | Euractiv.bg – Edited by Vasiliki Angouridi)

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